Scope and Purpose

958 CMR 11.00 applies to all Risk-bearing Provider Organizations and Accountable Care Organizations subject to the requirements of M.G.L. c. 176O, § 24, M.G.L. c. 6D, §§ 15 and 16. 958 CMR 11.00 establishes requirements for administering internal appeals processes and establishes the requirements for external review of appeals submitted by or on behalf of Patients of Risk-bearing Provider Organizations and Accountable Care Organizations.